Clever socks connecting remote patients and physios

For Australians living in rural and remote areas, access to many of the services urban dwellers take for granted, like physiotherapy, can be limited.

Increasingly, Australian physiotherapists are relying on video consultations to help treat rural and remote patients.

Consulting via video saves patients’ time and money, as they no longer have to endure the sometimes hours-long journey to hospital. However, the technology has its limitations - particularly the 2-dimensional view of the patient available to the physiotherapist.

But University of Melbourne PhD candidate Deepti Aggarwal, who is based in the Melbourne School of Engineering, has found a solution in perhaps the most unlikely of places – a pair of socks.

Ms Aggarwal’s socks are no ordinary pair. Her new ‘smart socks’ are essentially a piece of wearable technology that provides physiotherapists real-time information on a patient’s lower body movements.

The invention was motivated by Ms Aggarwal’s observations of physiotherapists at the Royal Children’s Hospital, and her father’s experience when he injured his ankle in his small hometown in India and was unable to seek professional treatment due to the cost involved in travelling to the nearest big city.

“Physiotherapy is all about movement,” says Ms Aggarwal.

“To assess patients’ recovery, physiotherapists must be able to closely observe the subtle differences in their movements.”

Ms Aggarwal watched physiotherapists during face-to-face and video consultations, helping patients with chronic pain recover their movements.

“What was lacking in video consultations was the ability to observe the subtle differences in patients’ lower limb movements, such as shifts in weight distribution and range of foot movements,” says Ms Aggarwal.

“This meant that physiotherapists had limited understanding of the patient’s actual recovery, leading to less specific treatment. The physiotherapists were also reluctant to try out new exercises with the patients over video.”

Keen to make a difference, Ms Aggarwal spent six months creating the world’s first ‘smart socks’, that allow physiotherapists to better assess and treat patients with lower limb issues during video consultations.

SoPhy consists of a pair of socks embedded with three sensors that, when worn by the patient, capture information about weight distribution, range of movement and foot orientation for the patient’s lower limb movements.

The socks are then coupled with a web-interface that presents the captured information to physiotherapists using foot sketches.

During a video consultation, the patient wears the SoPhy socks and performs exercises that they would do in a face-to-face session such as raising onto their tip-toes, squats and toe curls.

In Ms Aggarwal’s trial at the Royal Children’s Hospital, SoPhy was found to increase the physiotherapists’ confidence in their assessments by providing movement related information that wasn’t visible in the video. Patients on the other hand, received real-time feedback on the little changes in their movements that were difficult to understand otherwise. “They got a better understanding of what they should be doing instead of what they were doing, which made the therapy goals simpler and more achievable for them,” says Ms Aggarwal.

The information also helped physiotherapists to correct their assessment when the visual cues were misleading, allowing them to adapt the exercises based on the patient’s condition.

“Often, without realising it, patients will apply different tricks to not bear weight on the injured leg, such as pushing through their toes or heels,” says Ms Aggarwal. “These movements are so subtle that they can be missed by the naked eye, even in a face-to-face consultation. The SoPhy visualisation clearly highlights whether the patient is bearing any weight on the injured leg and in which parts, such as in the front, side or on the heels of the foot.”

Royal Children’s Hospital physiotherapist Mark Bradford, who was involved in the trial, says SoPhy became a shared language to discuss patients’ recovery over time and to plan new therapy goals, enhancing the physiotherapist-patient communication.

“SoPhy makes my intervention more accurate and specific,” says Mr Bradford.

“It gives me more clarity about what’s happening with the patient right now and helps me to decide the best treatment – showing patients exactly what to do, and how.”

Ms Aggarwal stresses that technologies like SoPhy are not a replacement for face-to-face consultations; rather they’re the next-best solution to support remote patients in critical situations such as those with severe pain and mobility issues.

“They can also enhance face-to-face consultations by providing another source of clinical information to help physios make the best assessment of the patient’s needs, and provide the most effective treatment plan.” Ms Aggarwal is planning to make video consultations smart and effective in other areas where care is limited, such as for pregnant women who can’t regularly travel for face-to-face appointments. This would involve development of other sensing technologies that are currently not available.

“Through SoPhy, we hope to inspire design thinking towards making novel systems for video consultations that sufficiently meet the needs of both patients and clinicians,” she says.

Ms Aggarwal was the 2017 Victorian Fresh Science winner, a national program that helps early-career researchers find and share their stories of discovery. Fresh Science Victoria is supported by the Royal Society of Victoria, the University of Melbourne, Monash University, CSIRO, Deakin University, RMIT University and La Trobe University.

Banner image: Getty Images